They cover the management of disorders of the digestive system (gastrointestinal and liver conditions) that are treated with drugs that affect the immune response and the care of people in hospital who develop heart problems (acute myocardial injuries) as a consequence of COVID-19 infection.
The guideline on gastrointestinal and liver conditions provides clinicians with advice on how to adjust care to reduce patients’ exposure to COVID-19 and how to balance the risks and benefits of taking drugs that affect the immune response during the pandemic.
It recommends that patients who are not known to have COVID-19 continue to take existing courses of drugs that affect the immune response to minimise the risk of a flare-up.
If a patient develops COVID-19 symptoms, it’s recommended that they contact their clinical team to get advice about any drugs they are taking.
Clinicians should then discuss the risks and benefits of stopping treatment with the patient or their parents or carers taking into account factors such as the severity of the COVID-19, the severity of their condition and other risk factors such as age and other health conditions.
The guideline on acute myocardial injury aims to help healthcare professionals who are not cardiology specialists to identify, monitor and treat heart problems in adults with known or suspected COVID-19 but without known pre-existing heart disease.
It highlights that acute myocardial injury was observed in 9.5% of all hospitalised patients dying in Italy with COVID-19 and that some of the symptoms are similar to the respiratory complications of COVID-19.
Symptoms of acute myocardial injury include chest pain, heart palpitations, severe tiredness and shortness of breath.
For all patients with a suspected or confirmed myocardial injury, clinicians should monitor the patient’s blood pressure, heart rate and fluid balance. Continuous ECG monitoring, to measure the heart’s electrical activity, is also recommended.
The guidance advises clinicians to be aware that treatments that may be used in COVID-19 clinical trials, such as azithromycin and hydroxychloroquine, may lead to an abnormal heartbeat (arrhythmia). At the time of publication (23 April 2020), azithromycin and hydroxychloroquine can only be used to treat COVID-19 as part of nationally approved randomised controlled trials.
Further guidelines will be announced in due course but are likely to include: the treatment of pneumonia in hospital, the management of acute kidney injury in patients with COVID-19 and the care of children and young people who are immunosuppressed. NICE will publish new guidelines each based on the priorities for patients and the NHS.
NICE will also make the guidelines internationally available so that health systems around the world can see the approach the UK is taking.
The guidelines are being produced in collaboration with NHS England/Improvement and a cross-specialty clinical group, supported by the specialist societies and Royal Colleges.